Home Health & Hospice Week

Nearly every MO item changes in revised assessment tool.

The patient assessment tool on which your payment and outcomes depend is about to get an extreme makeover--and it will mean more work for you.

The Centers for Medicare & Medicaid Services on July 27 released its revised OASIS draft. CMS plans to test the drastically revised tool in 11 home health agencies in Colorado, Massachusetts and Ohio this fall, the agency says in the Paperwork Reduction Act supporting statement for the revised form.

Timeline: If all goes as expected, CMS will revise the tool in light of the test results and then implement the new assessment form in early to mid-2009, a CMS official tells Eli. That would include time for comment on the revisions, the staffer notes.

HHAs will have a lot of revisions on which to comment, experts point out. "Nearly all of the existing OASIS items have changes in wording," says consultant Judy Adams with LarsonAllen based in Charlotte, NC. Many of the rest have at least changed M0 numbers. Nearly 30 Process-Based Measures Added--Along With Major Burden One of the biggest changes to the form is the addition of nearly 30 process-based measures that will start with "M1" instead of "M0." Clinicians won't have to answer every process question at every timepoint, CMS points out.

The new questions cover patient education, vaccination history, physician communication, pain, volume overload, pressure ulcers, foot care, depression, fall risks and medication.

"Process measures that support evidence-based practices ... prevent exacerbation of serious conditions, can improve care received by individual patients, and can provide guidance to agencies on how to improve care and avoid adverse events." CMS says.

Increased workload: But the process-based measures CMS wants to include could translate to a lot more work for clinicians filling out OASIS. The feds claim the added burden is negligible. That's because CMS is also cutting some items not used for payment, quality or risk adjustment; streamlining other items; and requiring process items only for some timepoints or, in some cases, certain times of the year.

"Total impact of proposed OASIS revisions, including both elimination, revision and addition of items, changes the estimated burden of the OASIS very little while incorporating process measures," CMS maintains in the PRA supporting statement.

But experts disagree. The process items are "more work intensive than those that were deleted," argues consultant Pam Warmack with Clinic Connections in Ruston, LA. "This is not an equal trade off."

"No matter how 'easy' an item is to collect, the mere addition of a new item requires some education and learning curve burden," adds OASIS consultant Linda Krulish with OASIS Answers in Redmond, WA.

And many of the process items will be far from easy, Krulish notes. "Some of these items will [...]